The choice of of ef ficient treatment of uterine sarcomas is challenge, due to the high malignancy and aggressiveness of the tumor, on the one hand, and the lack of a suf ficient amount for the treatment of uterine sarcomas studies on the other. The authors have shown to be promising, and the importance of choosing an adequate level of surgical
treatment and the selectivity in the choice of additional methods of complex treatment. The ar ticle presents the results of treatment of sarcomas of the uterine body cancer (gynecologic) Department of Regional Oncology Center.

Background. It is well recognized that pancreatic ductal adenocarcinoma (PDAC) is associated with very poor prognosis, early locoregional invasion and distant metastases. One reason for this is the proliferation of tumor growth through perineural spaces.
Aim. To evaluate the efficacy of intraoperative radiation therapy (IORT) for the extrapancreatic perineural invasion (EPPI) in the development of locoregional recurrence in patients with PDAC.
Results. In 14.5% (22/152) the tumor was pT1–2, pN0, extraPn 0, R0. R1 detected in 32.1% (49/152). ExtraPn was detected in 36.8% of cases (56/152). Metastases in regional lymph nodes was found in 62.5% (95/152) of cases. In the study of autopsy
basic morphological parameters speakers include locoregional tumor progression and / or a distant progression. Locoregional recurrence was found in 85% of cases (29/34), which is manifested by the presence of perineural invasion. The mean time from surgery until locoregional recurrence without extraPn –14 months, with the presence of extraPn – 9 months.

Conclusion. Thus, the absence of regional lymph nodes and/or with positive surgical margin does not preclude the development of locoregional recurrence in patients with PDAC. This is what necessitates a combined approach to the treatment of these patients, including surgery, supplemented by conducting IORT that effectively influences on tissues and reduces the number of local recurrence.

Cutaneous melanoma is 1–4% of all cancers. Among all malignant skin tumors, melanoma has a special place, it accounts for about 4% of all forms of skin cancer, but 80% of deaths in the group of malignant tumors of the skin caused by melanoma. In 2014 in Russian Federation, the standardized death rate from melanoma of the skin was 1.51 per 100 000 population. The incidence of melanoma has been steadily growing in Russian Federation and many other countries. In absolute increase the incidence of all malignant tumors, skin melanoma is ranked 2nd after lung cancer. Increased incidence of melanoma necessitates in-depth study of the biology of this tumor and its interaction with the immunobiological control system. Considering the immunogenicity of melanoma, the importance of the nature of the immune response to growing tumor. Therefore, one of the most important prognostic factor of the disease in these patients is the severity and subpopulations of lymphoid infiltration of the tumor, which is also important for the selection of personalized
treatments with modern immunotherapeutic drugs, such as ipilimumab, which is the biological target for T cell suppressor receptor CTLA- 4.

High mortality rates from malignant neoplasms and the associated substantial socio-economic losses can reasonably consider the fight against malignant tumors as a problem for the state. The main work on early detection of oncological diseases in the General medical network. The obtained statistical data might be a basis for the development of interventions aimed at improving morbidity and mortality from malignant neoplasms.

The paper reflected the background of the concept, history of lymphography, as well as the current understanding the problem by studying of the concept of sentinel lymph nodes in  malignant tumors. As metastasis to regional lymph nodes is the first step in the spread of most malignant tumors the status of the regional lymph node has diagnostic value for
determining the degree of malignancy. The combination of two imaging techniques of sentinel lymph node allows to identif y in almost cases, including in any tumor location even in uncer tain direction of lymph flow. In case of the negative sentinel lymph
node can be argued on the absence of metastases in other lymph nodes. Routine histological study of the lymph node should be completed by Immunohistochemistry analysis (Real-time PCR). Therapeutic lymph node dissection should be performed only by histological and Real-time PCR verification of tumor metastases in lymph nodes. In case of detection of micrometastases in lymph node remote question of the advantage of total lymph nodes dissection requires the fur ther discussion.

Aim: to analyze the results of treatment with vinorelbine in patients with metastatic breast cancer (BC).
Patients and methods: There were 5943 of new cases of BC in Moscow and there were 2378 patients with IV stage of the disease. 113 patients were treated with vinorelbine as a monotherapy, 1056 had other options of chemotherapy and 1209 patients had no treatment. As a first-line therapy vinorelbine was used in 13.5% of patients, as a second-line – in 59.7% and as a third-line – in 26.8%.
Results: There were no significant difference in 1-year survival between group of treatment with vinorelbine (CI 95%; 0.25–1.0), group of other options of chemotherapy (CI 95%; 0.47–1.0) and group with no treatment (CI 95%; 0.32–0.49). But there were a clear tendency of increasing of difference between vinorelbine group and group without treatment.
Conclusion: Vinorelbine is an ef fective and well-tolerated agent in patients with metastatic BC. But randomized multicenter trials are needed to evaluate ef ficacy of vinorelbine as a
monotherapy.

The aim of the work was to study a number of molecular biological tumor markers as selection criteria methods of accompanying extracorporeal immunopharmacotherapy
(EIFT) in patients with ovarian cancer (OC). The object of the study were 30 patients with OC with II–III clinical stages of the disease who were treated in gynecological cancer RORC MoH Uzbekistan office from 2009 to 2011 years and treated with standard combination therapy. Most of the patients with OC (83.3, 86.7 and 80.0%, respectively) were present molecular biological markers p53, VEGF and Ki‑67. At the same time, the
markers HER‑2/neu and EGFR were found in 20.0% of patients and 30.0 respectively. It is shown that the greatest prognostic value regarding the efficacy of the treatment of patients with OC have tumor markers p53, VEGF and Ki‑67, and the level of proliferative activity (PA) of the tumor. The greatest effect in increasing the 5-year survival of patients immunotherapy has provided the accompanying diagram including EIFT with
plasmapheresis. Positive okomarkerov level of p53, VEGF and Ki‑67 in patients with OC, along with high PA tumors can serve as a basis for this category of patients with immunotherapy accompanying EIFT. In the case of positive values of all the above molecular biological factors, we recommend carrying out the accompanying EIFT with plasmapheresis, which can significantly increase the effectiveness of standard anticancer
treatment schemes.

Triple-negative breast cancer (TNBC) is definied by the lack of expression of the estrogen receptor, progesterone receptor and HER2. TNBC has been characterized by aggressive course,
early development of metastases, poor overall survival rates compared to other subtypes of breast cancer. Molecular genetic studies have allowed to discover different molecular subtypes of TNBC (i. e., basal-like, claudin-low), demonstrated the presence of «immune-activated» subtypes with better disease outcome. In addition, further studies have characterized molecular features characteristic of TNBC, including a high rates of TP53 mutations, MEK and PI3K pathway activation, loss RB1 protein function, genetic similarities to serous ovarian cancers, including inactivation of BRCA pathway. Understanding of the genetic heterogeneity of TNBC led to promising therapeutic approaches, including DNA-damaging agents (i. e., platinum salts and PARP inhibitors) and immunotherapy currently. Platinum  salts became a standard component in the chemotherapy regimens for patients with metastatic TNBC. The best outcomes are observed among patients with BRCA-mutation. Furthermore, the use of platinum salts in neoadjuvant regimens showes higher pathologic complete response rates. The presence of tumor infiltrating lymphocytes in TNBC carries prognostic role. The use of checkpoint inhibitors, including PD‑1 and PD-L1 inhibitors, actively investigated in the setting of metastatic TNBC. For oncologists it’s very important to have ability to assign the optimal therapeutics regimens, based on knowledge of the heterogeneity of TNBC, that would led to improve patient outcome.

Triple-negative breast cancer (TNBC) represents approximately 15% –20% of all diagnosed breast cancers. This tumor subtype characterized by the absence of expression of the estrogen receptor (ER), progesterone receptor (PgR), and human epidermal growth factor (HER2) protein. Tumor heterogeneity of triple negative breast cancer is the main barrier in the treatment of this tumor subtype. Although estrogen receptor (ER) and human epidermal growth factor receptor (HER2) are the mainstay therapeutic targets in breast cancer, the androgen receptor (AR) is evolving as a molecular target for cancers that have developed resistance to conventional treatments.

The analysis of cases of primary hyperparathyroidism was undertaken during 2010–2016 years. Determined that none of 18 patients, operated in the clinic, had visceral or kidney forms of hyperparathyroidism. All patients had bone form, manifesting pathological fractures, stimulating tumor growth or severe osteoporosis, in 14 patients the diagnosis was suspected from laboratory studies (parathyroid hormone, blood calcium, alkaline
phosphatase), upon further examination were found parathyroid adenoma. After surgical treatment, all patients recovered without recurrence and postoperative complications. In our cases, the most characteristic picture of hyperparathyroidism has X-ray examination of the skull bones, in the form of osteolysis or cystic bone reconstruction. It should be noted that primary hyperparathyroidism masked in some cases of osteoblastoma that often leads to misdiagnosis and wrong treatment strategy. These clinical manifestations of primary hyperparathyroidism make clinicians more cautious with this disease.

In recent years there were significant advances in auto- and heterological breast reconstruction. Reconstruction with implants after mastectomy is being used more of ten. A recent study conducted by Albronoz et al, based on Nationwide Inpatient Sample data, found an increasing rate of immediate breast reconstruction with implants af ter mastectomy up to 11%, compared to autological methods of reconstruction [Barreau-Pouhaer L., 1992]. A possible reason for this increase is the growing number of young patients who need a mastectomy, but have not enough fat tissue for autological reconstruction. The purpose of reconstruction is to reach a long-term, oncologically safe and aesthetically pleasing result with reasonable operation expenses. Radiation therapy after mastectomy, as part of a complex treatment, is needed for an increasing amount of patients with breast cancer. Radiation therapy is a vital par t of cancer treatment, but often causes complications. Patients should be informed and consulted about potential complications so they can make reasonable decisions about their treatment.

Complete pathological tumor response is now considered the main criterion of effectiveness of neoadjuvant therapy and has great prognostic value. The paper describes the modern approach to the definition of residual tumor in breast cancer patients after
neoadjuvant chemotherapy, the criteria of a full morphological regression according to the latest clinical guidelines.

Immunotherapies enhance patients’ endogenous immune system function of attacking tumor cells, and are being widely and successfully used in the field of immuno-oncology. Adoption of assumptions based on more traditional chemotherapy-based responses can lead to significant operational difficulties and inaccurate interpretation of responses seen. It is therefore important to choose the appropriate clinical response criteria. These topics are addressed in this white paper.